Clinical Ophthalmology (Sep 2020)
Minimally Invasive Surgery in Mild-to-Moderate Glaucoma Patients in Italy: Is It Time to Change?
Abstract
Ciro Costagliola,1 Mario Sbordone,2 Stefano Gandolfi,3 Luca Cesari,4 Gianluca Furneri,5 Antonio Maria Fea6 1Department of Medicine & Health Sciences “V. Tiberio”, University of Molise, Campobasso, Italy; 2Ophthalmology Unit, Santa Maria Delle Grazie Hospital, Pozzuoli, Naples, Italy; 3Ophthalmology Unit, Department of Biological, Biotechnological and Translational Sciences, University of Parma, Parma, Italy; 4UOC Ophthalmology - Area 5, Ascoli Piceno, San Benedetto del Tronto, Italy; 5EBMA Consulting SRL, Melegnano, Milan, Italy; 6Department of Surgical Sciences, University of Turin, Turin, ItalyCorrespondence: Gianluca FurneriEBMA Consulting SRL, Via per Carpiano, 2 – 20077, Melegnano, MI ItalyEmail [email protected]: Medical therapy is the first treatment choice for most patients with glaucoma; however, in a relevant proportion of patients, intraocular pressure (IOP) reduction is achieved with multi-therapy and/or high therapeutic doses. Conventional surgery is the standard alternative to medical therapy when this is not effective or not tolerated. Recently, selective laser trabeculoplasty (SLT) has been advocated as first-line therapy, and “minimally invasive glaucoma surgery” (MIGS) has been developed as safer and less traumatic surgical intervention for patients with glaucoma. Schlemm’s canal surgery has emerged as one of the approaches with the most favorable risk-benefit profile for glaucoma patients in need of cataract surgery. However, despite the promising results, use of MIGS in Italy has been extremely low. We aimed to investigate the reasons of the lower-than-expected use of Schlemm’s canal-based MIGS devices in Italy, share our perspective on their potential place in therapy, and give practical suggestions to improve the management of glaucoma patients.Keywords: minimally invasive surgery, glaucoma, IOP reduction, trabecular bypass, cataract surgery
